What to Expect During an InfantSEE Assessment
Undetected and untreated eye and vision disorders, such as amblyopia and strabismus, too often become barriers to learning, leading to delayed reading and poorer outcomes in school. In-person comprehensive eye exams provided by a doctor of optometry are essential and thoroughly effective at identifying and ensuring early treatment for the range of vision and eye health issues that can impact a child's development and learning abilities.
While many parents may think that a vision screening is enough, a study funded by the National Eye Institute found that even the most sophisticated vision screening tools, administered by the most highly-trained vision screeners, will miss one-third of children with an eye or vision disorder. InfantSEE provides early intervention using necessary specialized equipment and procedures-which are not available as part of most vision screenings.
Since many eye problems arise from conditions that can be identified by an eye doctor in the infant's first year of life, a parent can give an infant a great gift by seeking an InfantSEE assessment in addition to the wellness evaluation of the eyes that is done by a pediatrician or family practice doctor. During an InfantSEE assessment, a doctor of optometry will cover the following:
Some eye conditions are strongly linked to family history, so the first step for the optometrist is to compile a history on the child. A comprehensive patient history for infants may include any problems you have noticed, visual and ocular history, general health history, family eye and medical history, developmental history and demographic data. Factors placing an infant, toddler, or child at significant risk for visual impairment include: Optometrists have the clinical background and expertise necessary to provide eye and vision assessments for non-verbal patients, including infants. The optometrist is looking for answers to the same questions you are:
- Family history of eye diseases such as retinoblastoma, congenital cataracts, or metabolic or genetic disease
- Infection of mother during pregnancy (e.g., rubella, toxoplasmosis) or drug/alcohol use during pregnancy
- Sexually transmitted diseases, cytomegalovirus, or HIV
- Difficult or assisted labor, which may be associated with fetal distress or low Apgar scores
Because traditional eye chart testing requires identification of letters or symbols and demands sustained attention, this test cannot be used with infants and toddlers. Assessment of visual acuity for infants and toddlers may include tests to assess that the infant can fix his eyes on an object and follow the object, or at which objects the baby prefers to look, and at what distances.
The doctor may use lenses and light from a small hand-held instrument to assess how the eye responds to particular targets. The doctor may also repeat this test after using eye drops to enlarge the pupil and stabilize the baby's focusing. As an alternative, some doctors use photographic testing to then analyze the pupil reflex in the photo. The typical infant may have some degree of nearsightedness, farsightedness, and astigmatism not requiring correction. Studies show that 30 to 50 percent of infants under 12 months have significant astigmatism, which declines over the first few years of life, becoming stable between approximately 2½ to 5 years of age. Low amounts of anisometropia (where the refraction is not the same in both eyes) are common and variable in infants.
Using her hands, a light, or a toy, the optometrist catches the baby's attention and observes how the baby follows the movements of the object.
Eye Alignment/Binocular Potential
By covering one eye at a time, the optometrist gathers information about the eye muscles and acuity. While identifying strabismus is important in itself, the presence of strabismus may indicate any number of disease entities.
The optometrist will examine the eye's structure as well as eyelids, tear ducts, and other parts of the eye. Pupil function will be checked, and a hand-held biomicroscope may be used for evaluation of the front of the eye. A test to assess visual field will be completed and an examination of the inner eye through a dilated pupil will be done. An ideal time for evaluation of the posterior segment is when the infant is in a calm, relaxed, condition (i.e., being bottle fed or sound asleep).
In addition to sharing her findings with you, you may request the optometrist to send summary letters to the infant's pediatrician, family physician, or other appropriate practitioner, reporting and explaining any significant condition diagnosed in the course of the assessment.